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Flashcards in Diabetes Deck (36)
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1
Q

what 3/4 features support a diagnosis of hyperosmolar hyperglycaemia syndrome?

A
  • hypovolemia
  • hyperglycaemia
  • no ketones or acidosis
  • osmolality usually >320 mosmol/Kg
2
Q

what type of diabetes (I or II) is HHS more common in?

A

type II diabetes

3
Q

what can precipitate a patient getting HHS?

A
  • cardiac event
  • infection/sepsis
  • fall
  • stroke
    (can take days to develop)
4
Q

what is the immediate management of HHS?

A
  • IV fluids (crystalloids - given over 2/3 days)
  • normalise blood glucose by giving IV insulin
  • anticoagulation
  • monitor potassium and renal function
5
Q

what are the main complications of HHS?

A
  • central pontine myelinolysis
  • CCF from fluid overload if previous CVD
  • cerebral oedema
  • thrombosis
6
Q

what is diabetic ketoacidosis?

A

a condition that occurs most commonly in T1DM patients where they dont have enough insulin and ketones start to build up due to enhanced lipolysis

7
Q

what are teh main features that support a diagnosis of ketoacidosis?

A
  • acidosis
  • hyperglycaemia
  • ketonaemia
8
Q

what is the immediate management of DKA?

A
  • fluids FAST @ fixed rate
  • insulin to reduce ketones
  • potassium - as falls when insulin given
  • correction of electrolyte imbalances using fluids
9
Q

when is a patient moved from IV insulin to subcutaneous after DKA?

A

when their ketone level is <0.6mmol/L and they are ready to eat

10
Q

what investigations need to be doen when a patient comes in suspected of having DKA?

A
  • blood ketones
  • capillary blood glucose
  • venous plasma glucose
  • U+E’s
  • venous blood gases
  • FBC
  • blood cultures
  • ECG
  • CXR
  • urinalysis and culture
  • continous cardiac monitoring
11
Q

what are the clinical features of a diabetic foot?

A
  • painless ulcer
  • cellulitis possibly
  • redness
  • changes to skin, nails
  • foul smell
  • discharge
  • swelling
12
Q

what are the investigations needed when assessing a diabetic foot?

A
  • clinically
  • doppler
  • angiography
  • xray (if bone deformity/osteomyelitis)
  • FBC, swab and blood cultures (if infection)
13
Q

what is the management fo a diabetic foot ulcer?

A
  • remove callus/tissue debridement and washout
  • regular chiropody
  • bed rest
  • therapeutic shoes
  • if cellulitis then ABx
14
Q

what are teh most common types of organisms cuasing diabetic foot ulcers? and what ABx therefore needed to treat?

A
  • staphs and streps

- benzylpenicillin and flucloxacillin +/- metronidazole

15
Q

name some chronic complications of diabetes?

A
  • diabetic foot ulcer
  • nephropathies
  • neuropathies
  • retinopathy
16
Q

what are teh clinical features of a charcots foot?

A

pes cavus, claw toes, loss of transverse arch, rocker-bottom sole

17
Q

what is the main investigation for diabetic nephropathy?

A

albumin:creatinine ratio (≳3mg/mmol in microalbuminuria but urine dipstick -ve for proteins)

18
Q

what is the management of diabetic nephropathy?

A
  • ACEi
  • lifetsyles managament
  • BP control
  • glycaemic control
  • low protein diet
19
Q

what investigations are done to test for diabetic neuropathies?

A

clinical diagnosis
fasting blood glucose
HbA1c
serum thyroid-stimulating hormone

20
Q

what is the clinical plasma glucose level for hypoglycameia?

A

<3mmol/L

21
Q

what are teh clinical features of hyoglycaamia?

A
  • sweating
  • palpitations
  • shaking
  • hunger
  • confusion
  • drowsiness
  • speech difficulty
  • incoordination
  • headache
  • nausea
  • seizures
  • coma
22
Q

what are teh causes of hypoglycaemia? in diabetics and non diabetics?

A

↑activity, missed meal, accidental or non-accidental overdose, insulinoma

non diabetics: alcohol, starvation, lvier fialure, addisons, pituitary insufficeincy, certain medication e.g. aspirin, ACEi,,

23
Q

what is the whipples triad for hypoglycaemia?

A

it confirms a diagnosis of hypoglycaemia:

symptoms or signs of hypoglycemia + ↓plasma glucose + resolution of symptoms or signs post glucose rise

24
Q

what investigations are done when a patient presents with hypoglycaemia?

A
  • whipples triad
  • DHx to exlude liver failure
  • document BM during attack
25
Q

what is the treatment for hypoglycaemia?

A

If conscious, and able to swallow, give 15–20g of quick-acting carbohydrate snack and recheck blood glucose after 10/15mins (repeat snack up to 3 times).
If conscious but uncooperative, squirt glucose gel between teeth and gums.
In unconscious patients, start glucose iv or give glucagon

Once blood glucose >4.0mmol/L and patient has recovered, give long-acting carbohydrate

26
Q

what are the main acute complications of diabetes?

A
  • DKA
  • HHS
  • hypoglycaemia
27
Q

what are the clinical features of a fundoscopy for diabetic retinopathy?

A
  1. Microaneurysms (dots), haemorrhages (blots), and hard exudates (lipid deposits)
    2, Cotton-wool spots (eg infarcts), haemorrhages, venous beading
  2. New vessels form
28
Q

what are the features for a diagnosis of diabetes mellitus?

A
  • Symptoms of hyperglycaemia (eg polyuria, polydipsia, unexplained weight loss, visual blurring, genital thrush, lethargy) and raised venous glucose detected once—fasting ≥7mmol/L or random ≥11.1mmol/L OR
  • Raised venous glucose on two separate occasions—fasting ≥7mmol/L, random ≥11.1mmol/L or oral glucose tolerance test (ogtt)—2h value ≥11.1mmol/L OR
  • Hba1c ≥48mmol/mol
29
Q

management of TIDM?

A

insulin

30
Q

what are the four mian types of subcut insulin?

A

1 Ultra-fast acting (Humalog; Novorapid); inject at start of meal, or just after

2 Isophane insulin (variable peak at 4–12h): CHEAP

3 Pre-mixed insulins (NovoMix 30 = 30% short-acting and 70% long-acting).

4 Long-acting recombinant human insulin analogues (insulin glargine) are used at bedtime in type 1 or 2 dm. There is no awkward peak, so good if nocturnal hypoglycaemia is an issue. Caution if considering pregnancy. Insulin detemir is similar and has a role in intensive insulin regimens for overweight type 2 dm.

31
Q

what are the three different types of insulin regimes?

A
  • ‘bd biphasic regimen’: twice daily premixed insulins by pen (NovoMix 30®)—useful in type 2 dm or type 1 with regular lifestyle.
  • ‘qds regimen’: before meals ultra-fast insulin + bedtime long-acting analogue: useful in type 1 dm for achieving a flexible lifestyle
  • Once-daily before-bed long-acting insulin: a good initial insulin regimen when switching from tablets in type 2 dm. Consider retaining metformin (±pioglitazone)
32
Q

WHat is DAFNE?

A

dose adjustment for normal eating:
a course that aims to help adults with type 1 diabetes lead as normal a life as possible, whilst also maintaining blood glucose levels within healthy targets, to reduce the risk of long-term diabetes complications

33
Q

how should insulin dosing chnage in a T1DM patient with an acute illness

A

advise patietns to stop insulin during an episode of acute illness, need to :
Check blood glucose ≥ 4 times a day and look for ketonuria. Increase insulin doses if glucose rising. Advise to get help from a specialist diabetes nurse or gp if concerned

34
Q

when are insulin pumps needed?

A

Consider when attempts to reach Hba1c with multiple daily injections have resulted in disabling hypoglycaemia or person has been unable to achieve target Hba1c despite careful management

35
Q

what HbA1c is aimed for in diabetes?

A

<48mmol/mol or 53 if two or more agents

36
Q

name the 6 different types of oral hypoglycaemics (briefly mention their action)

A
  1. biguanide - metformin (increase insulin sensitivity)
  2. glitazones - pioglitazone (increase insulin sensitivity)
  3. DPP-4 inhibitors - sitagliptin (increase incretin - hormone that triggers insulin release)
  4. sulfonylurea - glicazide (increase insulin secretion)
  5. SGLT2 inhibitors - dapagliflozin (increased glucose excretion)
  6. GLP-1 receptor agonists - exenatide (incretin mimetic)